DBT LBC Certification Study Guide
According to Linehan, BPD clients possess 6 behavioral patterns. These are: -
answeremotional vulnerability, self invalidation, unrelenting crisis, inhibited grieving,
active passivity, and apparent competence
Linehan's criteria for BPD is most similar to - answerMillon
What % of BPD client's engage in self-injurious behaviors? - answer70-75%
Kreitman introduced this term meaning nonfatal, intentional self injurious behavior
resulting in actual tissue damage, illness, or risk of death; or 2) ingestion of any drugs or
substance not prescribed or in excess to the prescription with intent to cause harm or
death. This term includes both SI gestures and self injurious behaviors with little or not
intent to cause death. - answerparasuicide
4 differences between CBT and DBT: - answer1) Emphasis on acceptance and
validation of behavior as it is in the moment
2) Emphasis on TIBs
3) Emphasis on the therapeutic relationship
4) Focus on dialectical processes
The term "dialectics" as applied to behavioral therapy has come to imply 2 contexts of
usage: - answer1) fundamental nature of reality and persuasive dialogue and
relationship.
2) Treatment approach or strategies used by the therapist to effect change.
Dialectics as a worldview has 3 traits: - answer1) interrelatedness and wholeness
2) Principles of Polarity (within dysfunction there is function, wise mind, finding value in
one's pt of view, looking for the function within the present moment)
3) Thesis, Antithesis, Synthesis: Principles of Continuous Change
Borderline splitting is defined as - answertendency to get stuck in either the thesis or the
antithesis, unable to move to a synthesis. Either/or thinking
The environment- person system is comprised of the: - answerenvironmental sub-
system (social support, life change, suicidal, suicidal consequences) demographic
factors (age, sex, and race), and behavioral subsystem ( cognitive, over motor, and
physiological affective system)
Grostein proposed bpd is a disorder of - answerself regulation
characteristics of emotional vulnerability includes : - answerhigh sensitivity to emotional
stimuli, emotional intensity, slow return to emotional baseline.
emotional regulation requires 2 paradoxical strategies - answer1) the individual must
learn to experience and label the discreet emotions
2) the individual must learn to reduce emotionally relevant stimuli that serve either to
reactivate and augment ongoing negative emotions or to set off secondary dysfunctional
emotional responses.
inhibition of emotions can lead to - answer1) neglect of the problem situation causing
the emotions
2) increase in emotional avoidance (emotion phobic)
,3) research is unknown on the outcome of emotion inhibition over the long term
Poorness of fit results (Chess and Thomas) - answerwhen there is discrepancies and
dissonances between environmental opportunities and demands and the capacities and
characteristics of the child. In these instances , distorted environment and maladaptive
functions results.
Per Linehan, an invalidating enivorment: - answeris one in which communication of
private experiences is met by erratic, inappropriate, and extreme responses.
Invalidation has 2 primary traits - answer1) it tells the person that they are wrong 2) it
attributes her experiences to socially unacceptable characteristics or personality traits
consequences of invalidating environments - answer1) emotional labeling is not
learned, 2) distress intolerance and unrealistic goals/ expectations are instilled, 3)
extreme behavioral displays are used to get needs met, 4) lack of trust of one's own
emotional and cognitive interpretations are instilled
what are the 3 types of invalidating family systems - answer1) perfect family
2) chaotic family
3) typical family
This family type struggles with multiple issues within the family system, needs of the
child are ignored and invalidated, there is volatile responses, etc - answerChaotic
Family
This family type cannot tolerate the negative emotions of the child. This can be due to
high work demands, self-centeredness, intolerance of negative emotions, and naive
fears of spoiling the child. This family system has sympathy for their child but
unknowingly can invalidate by offering over simplified solutions to their child, ie pray
about it - answerperfect family
This family system exists within the western cultures and supports the idea of cognitive
control with focus on achievement above all else. Self-control is move important. -
answerTypical family system
Active Passivity is similar to _____ focused coping; ie the tendency to respond to
stressful events with efforts to reduce the negative emotional reaction by distracting or
seeking comfort from others. - answerEmotion
What factors contribute to apparent competency: - answer1) person's competence is
variable and conditional
2) person struggles with ability to be vulnerable with others
3) person's reaction to interpersonal relationships; ie the difference in behavior of the
person in a therapeutic relationship versus other outside relationships
The core strategies of dbt are: - answerproblem solving (change) and validation
(acceptance)
There are 2 types of validation strategies (ie core strategies): - answer1) wisdom within
the client's maladaptive behaviors based on the client's historical context
2) the therapist belief in the client's ability to build a LWL
Problem solving strategies (core strategies) include: - answer1) BCAs
2) Solutions Analysis
3) Orientation to the treatment solution
4) Eliciting commitment from the client
5) Application of the treatment
,The BCA includes the 4 following questions (BCA being a problem-solving strategies
which is a Core strategy) - answer1) Does the individual have the ability to engage in a
more adaptive response? (if not incorporate skills)
2) What are the reinforcing contingencies? (contingency management)
3) If adaptive responses are present, is their application inhibited by client's fear or
guilt? Is the client emotion phobic? (exposure therapy)
4) if adaptive responses are present, is their application inhibited by client's faulty
belief's or beliefs? (cognitive modification)
What are the two communication styles in DBT? - answerirreverent and reciprocal
What are the 4 modes of DBT treatment? - answerindividual therapy, dbt consult team,
dbt phone consultation, dbt skill class
How many DBT assumptions are there? - answer8
What are the DBT assumptions? - answer1) People are doing the best they can
2) People want to do better
3) People need to try harder and be more motivated to change
4) Clients cannot fail treatment
5) Therapist treating BPD must seek support
6) We did not cause all of our problems but we have to solve them anyways
7. The lives of SI clients are unbearable as they are being lived currently
8. Client must learn new behaviors in all relevant contexts
"Unwavering centeredness" is defined as - answerbelieving in oneself, in therapy, and
in oneself. It is the calmness in the storm.
"Compassionate flexibility" is defined as - answerAbility to adapt to changes within the
therapeutic relationship as needed. This includes admitting mistakes, observing and
extending limits as needed.
The balance "unwavering centeredness" and "compassionate flexibility" requires -
answerthe therapist observe limits and conditions while being flexible in response to
changing, adapting, etc.
"Nurturing" includes: - answerteaching, coaching, assisting, strengthening, and aiding
the patient
"Benevolent demanding" includes: - answertherapist recognition of the client's on
strengths and capability , reinforcement of their adaptive responses, and not taking care
of them
The dialectical position to take with benevolent demanding and nurturing is: -
answerPushing the client forward while supporting them.
Patient agreements include: - answer1) 1 year commitment to DBT
2) 4 missed shows in a row
3) Attendance agreement
4) SI agreement
5) TIB agreement
6) Skill training agreement
7) Research and payment agreement
Therapist agreements include: - answer1) Every reasonable effort agreement
2) Ethical agreement
3) Personal contact agreement
4) Respect for the client agreement
, 5) Confidentiality Agreement
6_ Consultation agreement
There is no absolute truth and when polarities exist the goal is to search for the
synthesis rather than the truth. - answerDialectical Agreement
Therapists do no serve as intermediaries for their patients with other professionals,
including other members of the treatment team. - answerConsultation to the client
Consistencies with other members of the treatment team are not expected and each
member of the team does not have to teach the same thing nor agree on proper rules of
the therapy. - answerConsistency Agreement
The case conceptualization group agrees that therapists are to observe their own limits
nor judge others limits. - answerObserving Limits Agreement
Therapist agree to search for a nonpejorative interpretation of clients behaviors -
answerphenomenological empathy agreement
Explicit agreement that all therapist are jerks. - answerFallibility agreement
There are 5 subcategories of SI-related behaviors which are targeted in DBT: -
answer1) SI Crisis behaviors
2) Parasuicidal acts (nonfatal, intentional self-injurious behaviors)
3) SI ideation and communications
4) SI- related experiences and beliefs (idea it is a problem-solving technique)
5) SI- related affect
Reducing Parasuicidal acts is important because: - answer1) best predictor of
subsequent SI
2) damages to the body
3) actions based on the intent to harm oneself are incompatible with therapy
4) It is hard to express care for a client if you do not address self-harm
There are 3 categories of client TIBs: - answer1) Behaviors that interfere with the client
receiving therapy
2) Behaviors that interfere with other clients receiving therapy
3) Behaviors that burn out the therapist
Examples of behaviors that interfere with the client receiving therapy - answer1.
Nonattentive- cancellations, threatening to drop out, dropping out, excessive admittance
into HOS, acting SI during inpatient stays
2 Noncollaborative- inability or refusal to work in therapy, not talking in therapy, arguing
incessantly
3 Noncompliant behaviors- not completing diary cards, not keeping agreement, refusing
treatment agreements
What are the 2 categories of TIBs of the therapist? - answer1) Balance within therapy
2) Respect for client
To be considered a Quality of Life interfering behavior the patient's behavior must..... -
answerbe interfering enough that if not changed it will interfere with a change in quality
of life. Examples include substance abuse, high risk or unprotected sex, extreme
financial issues, criminal behaviors, serious dysfunctional interpersonal behaviors,
employment or school related dysfunctional behaviors, illness related dysfunctional
behaviors, housing related dysfunctional behaviors, mental health related dysfunctions
behaviors
According to Linehan, BPD clients possess 6 behavioral patterns. These are: -
answeremotional vulnerability, self invalidation, unrelenting crisis, inhibited grieving,
active passivity, and apparent competence
Linehan's criteria for BPD is most similar to - answerMillon
What % of BPD client's engage in self-injurious behaviors? - answer70-75%
Kreitman introduced this term meaning nonfatal, intentional self injurious behavior
resulting in actual tissue damage, illness, or risk of death; or 2) ingestion of any drugs or
substance not prescribed or in excess to the prescription with intent to cause harm or
death. This term includes both SI gestures and self injurious behaviors with little or not
intent to cause death. - answerparasuicide
4 differences between CBT and DBT: - answer1) Emphasis on acceptance and
validation of behavior as it is in the moment
2) Emphasis on TIBs
3) Emphasis on the therapeutic relationship
4) Focus on dialectical processes
The term "dialectics" as applied to behavioral therapy has come to imply 2 contexts of
usage: - answer1) fundamental nature of reality and persuasive dialogue and
relationship.
2) Treatment approach or strategies used by the therapist to effect change.
Dialectics as a worldview has 3 traits: - answer1) interrelatedness and wholeness
2) Principles of Polarity (within dysfunction there is function, wise mind, finding value in
one's pt of view, looking for the function within the present moment)
3) Thesis, Antithesis, Synthesis: Principles of Continuous Change
Borderline splitting is defined as - answertendency to get stuck in either the thesis or the
antithesis, unable to move to a synthesis. Either/or thinking
The environment- person system is comprised of the: - answerenvironmental sub-
system (social support, life change, suicidal, suicidal consequences) demographic
factors (age, sex, and race), and behavioral subsystem ( cognitive, over motor, and
physiological affective system)
Grostein proposed bpd is a disorder of - answerself regulation
characteristics of emotional vulnerability includes : - answerhigh sensitivity to emotional
stimuli, emotional intensity, slow return to emotional baseline.
emotional regulation requires 2 paradoxical strategies - answer1) the individual must
learn to experience and label the discreet emotions
2) the individual must learn to reduce emotionally relevant stimuli that serve either to
reactivate and augment ongoing negative emotions or to set off secondary dysfunctional
emotional responses.
inhibition of emotions can lead to - answer1) neglect of the problem situation causing
the emotions
2) increase in emotional avoidance (emotion phobic)
,3) research is unknown on the outcome of emotion inhibition over the long term
Poorness of fit results (Chess and Thomas) - answerwhen there is discrepancies and
dissonances between environmental opportunities and demands and the capacities and
characteristics of the child. In these instances , distorted environment and maladaptive
functions results.
Per Linehan, an invalidating enivorment: - answeris one in which communication of
private experiences is met by erratic, inappropriate, and extreme responses.
Invalidation has 2 primary traits - answer1) it tells the person that they are wrong 2) it
attributes her experiences to socially unacceptable characteristics or personality traits
consequences of invalidating environments - answer1) emotional labeling is not
learned, 2) distress intolerance and unrealistic goals/ expectations are instilled, 3)
extreme behavioral displays are used to get needs met, 4) lack of trust of one's own
emotional and cognitive interpretations are instilled
what are the 3 types of invalidating family systems - answer1) perfect family
2) chaotic family
3) typical family
This family type struggles with multiple issues within the family system, needs of the
child are ignored and invalidated, there is volatile responses, etc - answerChaotic
Family
This family type cannot tolerate the negative emotions of the child. This can be due to
high work demands, self-centeredness, intolerance of negative emotions, and naive
fears of spoiling the child. This family system has sympathy for their child but
unknowingly can invalidate by offering over simplified solutions to their child, ie pray
about it - answerperfect family
This family system exists within the western cultures and supports the idea of cognitive
control with focus on achievement above all else. Self-control is move important. -
answerTypical family system
Active Passivity is similar to _____ focused coping; ie the tendency to respond to
stressful events with efforts to reduce the negative emotional reaction by distracting or
seeking comfort from others. - answerEmotion
What factors contribute to apparent competency: - answer1) person's competence is
variable and conditional
2) person struggles with ability to be vulnerable with others
3) person's reaction to interpersonal relationships; ie the difference in behavior of the
person in a therapeutic relationship versus other outside relationships
The core strategies of dbt are: - answerproblem solving (change) and validation
(acceptance)
There are 2 types of validation strategies (ie core strategies): - answer1) wisdom within
the client's maladaptive behaviors based on the client's historical context
2) the therapist belief in the client's ability to build a LWL
Problem solving strategies (core strategies) include: - answer1) BCAs
2) Solutions Analysis
3) Orientation to the treatment solution
4) Eliciting commitment from the client
5) Application of the treatment
,The BCA includes the 4 following questions (BCA being a problem-solving strategies
which is a Core strategy) - answer1) Does the individual have the ability to engage in a
more adaptive response? (if not incorporate skills)
2) What are the reinforcing contingencies? (contingency management)
3) If adaptive responses are present, is their application inhibited by client's fear or
guilt? Is the client emotion phobic? (exposure therapy)
4) if adaptive responses are present, is their application inhibited by client's faulty
belief's or beliefs? (cognitive modification)
What are the two communication styles in DBT? - answerirreverent and reciprocal
What are the 4 modes of DBT treatment? - answerindividual therapy, dbt consult team,
dbt phone consultation, dbt skill class
How many DBT assumptions are there? - answer8
What are the DBT assumptions? - answer1) People are doing the best they can
2) People want to do better
3) People need to try harder and be more motivated to change
4) Clients cannot fail treatment
5) Therapist treating BPD must seek support
6) We did not cause all of our problems but we have to solve them anyways
7. The lives of SI clients are unbearable as they are being lived currently
8. Client must learn new behaviors in all relevant contexts
"Unwavering centeredness" is defined as - answerbelieving in oneself, in therapy, and
in oneself. It is the calmness in the storm.
"Compassionate flexibility" is defined as - answerAbility to adapt to changes within the
therapeutic relationship as needed. This includes admitting mistakes, observing and
extending limits as needed.
The balance "unwavering centeredness" and "compassionate flexibility" requires -
answerthe therapist observe limits and conditions while being flexible in response to
changing, adapting, etc.
"Nurturing" includes: - answerteaching, coaching, assisting, strengthening, and aiding
the patient
"Benevolent demanding" includes: - answertherapist recognition of the client's on
strengths and capability , reinforcement of their adaptive responses, and not taking care
of them
The dialectical position to take with benevolent demanding and nurturing is: -
answerPushing the client forward while supporting them.
Patient agreements include: - answer1) 1 year commitment to DBT
2) 4 missed shows in a row
3) Attendance agreement
4) SI agreement
5) TIB agreement
6) Skill training agreement
7) Research and payment agreement
Therapist agreements include: - answer1) Every reasonable effort agreement
2) Ethical agreement
3) Personal contact agreement
4) Respect for the client agreement
, 5) Confidentiality Agreement
6_ Consultation agreement
There is no absolute truth and when polarities exist the goal is to search for the
synthesis rather than the truth. - answerDialectical Agreement
Therapists do no serve as intermediaries for their patients with other professionals,
including other members of the treatment team. - answerConsultation to the client
Consistencies with other members of the treatment team are not expected and each
member of the team does not have to teach the same thing nor agree on proper rules of
the therapy. - answerConsistency Agreement
The case conceptualization group agrees that therapists are to observe their own limits
nor judge others limits. - answerObserving Limits Agreement
Therapist agree to search for a nonpejorative interpretation of clients behaviors -
answerphenomenological empathy agreement
Explicit agreement that all therapist are jerks. - answerFallibility agreement
There are 5 subcategories of SI-related behaviors which are targeted in DBT: -
answer1) SI Crisis behaviors
2) Parasuicidal acts (nonfatal, intentional self-injurious behaviors)
3) SI ideation and communications
4) SI- related experiences and beliefs (idea it is a problem-solving technique)
5) SI- related affect
Reducing Parasuicidal acts is important because: - answer1) best predictor of
subsequent SI
2) damages to the body
3) actions based on the intent to harm oneself are incompatible with therapy
4) It is hard to express care for a client if you do not address self-harm
There are 3 categories of client TIBs: - answer1) Behaviors that interfere with the client
receiving therapy
2) Behaviors that interfere with other clients receiving therapy
3) Behaviors that burn out the therapist
Examples of behaviors that interfere with the client receiving therapy - answer1.
Nonattentive- cancellations, threatening to drop out, dropping out, excessive admittance
into HOS, acting SI during inpatient stays
2 Noncollaborative- inability or refusal to work in therapy, not talking in therapy, arguing
incessantly
3 Noncompliant behaviors- not completing diary cards, not keeping agreement, refusing
treatment agreements
What are the 2 categories of TIBs of the therapist? - answer1) Balance within therapy
2) Respect for client
To be considered a Quality of Life interfering behavior the patient's behavior must..... -
answerbe interfering enough that if not changed it will interfere with a change in quality
of life. Examples include substance abuse, high risk or unprotected sex, extreme
financial issues, criminal behaviors, serious dysfunctional interpersonal behaviors,
employment or school related dysfunctional behaviors, illness related dysfunctional
behaviors, housing related dysfunctional behaviors, mental health related dysfunctions
behaviors
